Preventing and treating hypos.
Let’s start with a quick refresher on why sugar is a terrible choice for hypo treatment.
Remember the key problem? Half the grams in sugar are fructose, and fructose gets parked in the liver. So only about half your “treatment” actually treats the hypo.
That’s exactly why I needed three Coca-Colas just before bed on Christmas Day 2018… and then rocketed straight back up high.
This is the same sugar-rollercoaster this young lady was stuck on before using Dynamic Glucose Management.
And there’s a second hit: flooding the liver with fructose can flip on the overeating switch — the thing we unpacked from Peter Attia’s podcast with Rick Johnson.
Rick Johnson’s revolutionary insights into sugar and obesity
Here’s that mechanism again in one picture:
I’ve raided the fridge after a Coca-Cola “treatment” more times than I’d like to admit. Sugar creates the perfect storm: slow correction + repeat dosing + liver fructose = rebound highs and hunger chaos.
Now compare that with glucose — the clear winner for both preventing and treating hypos.
Two reminders to keep your head straight:
- The gut maxes out at about 1 gram of glucose absorbed per minute.
- It takes roughly 20 minutes for a treatment to show up clearly on CGM.
Swapping Coca-Cola for dextrose tablets is a big reason why hypo prevention worked so smoothly on Christmas Day 2019.
And after switching to Dynamic Glucose Management, this young lad stopped needing double treatments too.
Ready to take preventing lows to the next level?
What’s new about MATCH?
The new move is adjusting your glucose dose based on where you are and how fast you’re falling.
Not all hypos are the same, so they don’t deserve identical treatment.
If you’re dropping fast, you need more glucose. If you’re drifting down slowly, less will do the job.
Here’s how it works for me. I weigh 100 kg, so my full treatment is 18 g — six dextrose tablets.
If I’m at 5.5 mmol/L (100 mg/dL) and just falling, I take 50%: 9 g, or three tablets.
If I’m at 5.5 mmol/L (100 mg/dL) and falling rapidly, I take the full 18 g: six tablets.
Grace, you currently weigh 20 kg, so your full treatment is 6 g — two tablets.
If you’re at 3.5 mmol/L (65 mg/dL) and just falling, you take about 75%: 4.5 g, or one-and-a-half tablets.
If you’re at 3.5 mmol/L (65 mg/dL) and falling rapidly, you take about 125%: 7.5 g, or two-and-a-half tablets.
This graphic pulls MATCH together:
Then do the hardest bit: wait 20 minutes before deciding on a second treatment. That’s the time it takes for glucose to absorb and register on CGM. Jude — don’t be impatient.
Will this work perfectly every time?
Dani, you already know the answer: no.
This table is a solid guide for most people most of the time, but type 1 diabetes is highly individual and every hypo has a backstory. For example:
- How much bolus insulin is still circulating
- What activity/exercise you’ve done in the past 3 hours
- Heat and humidity
- How many hypos you’ve had in the last 24 hours
- And about 97 other annoying variables
So you’ll still learn on the job, guided by one rule:
Isn’t there a one-pager that pulls all this together?
I was thinking the same thing.
Next step: Infographic.
